INS CD-FACILITY BASED PROVIDER

If House Bill 5085 of the 96th General Assembly becomes law, amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to provide that a nonparticipating facility-based physician or provider may bill the beneficiary, insured, or enrollee for services determined by the insurer or health plan to be a noncovered service if the basis for denial is other than lack of medical necessity. Provides that a nonparticipating facility-based physician's or provider's acceptance of payment from an insurer or health plan regarding a claim in dispute prior to the initiation of arbitration shall not bar the initiation of arbitration by the nonparticipating facility-based physician or provider. Provides that nothing in the provision concerning nonparticipating facility-based physicians and providers shall be interpreted to change the prudent layperson provisions with respect to emergency services under the Managed Care Reform and Patient Rights Act. Sets forth provisions concerning arbitration. Effective upon becoming law or on the effective date of House Bill 5085 of the 96th General Assembly, whichever is later.